Journal Reviews
Weiss SJ, Takakuwa KM, Ernst AA. Use, understanding, and beliefs about complementary and alternative medicines among ED patients. Acad Emerg Med 2001; 8:41-47.
Although many ED patients use complementary and alternative medicine (CAM), a significant number of those patients would not tell their physicians about this, says this study from the University of California Davis Medical Center in Sacramento. Of 350 ED patients surveyed, 43% had used CAM, and 24% were currently using it. Only 67% of those patients said they would tell their doctor they were using CAMs. However, the researchers reviewed the charts of the patients who had stated they used CAMs and could find no indication of use.
"We suspect that the answer to this question referred to the patient’s private physician, and that even fewer believed they needed to tell an emergency physician," they theorize.
The researchers also noted that 16% of patients surveyed believed that "all herbal medications are safe." The most commonly used substances were ginseng (13%) and gingko biloba (9%), both of which have significant potential adverse effects, including subarachnoid hemorrhages, note the researchers. Increased CAM use has led to a rise in reports of toxic side effects including neurologic symptoms and hepatitis, they add. "Because of potential side effects and drug interactions, patients should be routinely questioned about CAM use," wrote the researchers.
Brymer C, Cavanagh P, Denomy E, et al. The effect of a geriatric education program on emergency nurses. J Emerg Nurs 2001; 27:27-32.
A one-day geriatric education workshop can significantly improve the way ED nurses care for elderly patients, says this study from the University of Western Ontario in Canada.
The workshop consisted of three 90-minute sessions on physical assessment of the elderly, mental status testing, and the difference between depression, delirium, and dementia. A total of 51 nurses were surveyed about their practice patterns before and after attending the workshop. In addition to the survey, changes in ED referral patterns for geriatric assessment and home care were monitored for two years after nurses attended the workshop to ensure the self-report data reflected their actual practice. Here are key findings from the nurses’ practice after the workshop:
- Patients were screened more frequently for depression, altered mental status, and dementia.
- Nurses asked patients about unplanned weight loss and if there was assistance in the home more often.
- There was a steady increase in the number of referrals to a home care program and a regional geriatric program.
The researchers recommend the use of targeted geriatric educational programs for ED nurses, including practical examples and case studies. "When an elderly patient visits the emergency department, it may be one of the only opportunities to recognize warning signs of impending but preventable decline in that individual’s health and independence," wrote the researchers.
Rhodes KV, Lauderdale DS, Stocking CB, et al. Better health while you wait: A controlled trial of a computer-based intervention for screening and health promotion in the ED. Ann Emerg Med 2001; 37:284-291.
Patients who used a self-administered computer survey for health screening while waiting were more likely to remember advice on what they could do to improve their health, according to this study from the University of Chicago. Patients with nonurgent conditions were asked to complete the survey, with a 89% participation rate. Those patients were willing to disclose behavioral risk factors, request health information and remember the advice they were given, say the study’s findings.
The researchers developed a computer-based assessment of health risks that could be modified by behavioral or lifestyle changes. Each completed interview contained answers to approximately 80 questions about the patient’s health and behaviors, with average response times of 15 minutes for men and 18 minutes for women, who are asked additional cancer and contraceptive-related questions. After completing the questionnaire, patients received individualized health recommendations and were invited to request additional information. Key findings include:
- Of the 248 patients who participated, 85% disclosed at least one behavioral risk factor, including smoking, problem drinking, inconsistent use of seat belts, major depression, or use of street drugs.
- 95% of patients who completed the questionnaire asked for additional information about specific health topics.
- In follow-up phone interviews, 62% of patients recalled receiving health advice.
The completed questionnaire generated a 10- page summary for the treating physician listing the patients’ major health risks and referral information. The researchers recommend that EDs consider using computer-based interactive technology during patient waiting time to educate patients and to identify individuals who might require specific interventions. "Our data suggest that the ED setting is conducive to providing a teachable moment for preventive health messages, regardless of whether those messages are related to the reason for the visit," they conclude.
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